Loading...
Akard, Mike CAMPAIGN FINANCIAL DISCLOSURE STATEMENT For State and Local Candidates For Single-Candidate Committees R CO ITTEE 1. DATE OF REPORT 12.a. NAME ~F NDIDAT OV~(.j b 2.b. IF ITTEE,'MANIE A OF CANDIDATE 3. ELECT DA E 4.a. CAMPAIGN ADDRESS AND PHONE o Street or Rural Rou City State Zip Code Phone eke dv 1 C o q 70 -4 3 4.b. CANDIDATE'S HOME ADDRES (if different than 4.a.) Street or Rural Route City State Zip Code Phone 5. OFFICE SOUG T (include district number, if applicable) 6. NAME OF POLI ICAL REA RER (may be candidate) C s s~ i~, 7. CATEGORY OR REPOR eck one) ❑ ❑ ❑ ❑ ❑ FIRST SECOND THIRD FOURTH PRE- PRE- MID-YEAR YEAR-END QUARTER QUARTER QUARTER QUARTER PRIMARY GENERAL SU PLEMENTAL SUPPLEMENTAL 8.a. BEGINNING DATE OF EPO TING PERIOD 8.b. ENDING DATE OF R(PO INW RJOD 19 ~yR,', S 1+1vC 9. (Check one) a. This campaign is exempt from detailed disclosure because contributions (including in-kind) received total $1,000 or less AND expendi- tures total $1,000 or less for this reporting period. (Complete items 12d., 12e. and 12f.) b. ❑ This campaign is required to file a detailed financial disclosure because contributions (including in-kind) received total more than $1,000 and/or expenditures total more than $1,000 for this reporting period. 10. I/we do solemnly swear or affirm that the information contained in this campaign financial disclosure report is true and that this report is an accurate accounting of campaign contributions and expenditures required to be reported by the candidate committee by the Campaign Financi sclosur Act. Additionally, ]/we swear or affirm that no campaign contributions have been expended for the personal financial benefit a cand' a or for y other nonpolitical urposq as defined by the federal in I rev nue code. signature of candidate date g olitical treasurer date 11. WITNESS SIGNATURE signature of witness date signature of witness date 12. SUMMARY ~'O~ 5 a. BALANCE ON HAND LAST REPORT $ v b. TOTAL RECEIPTS THIS PERIOD $ -IoC~W c. TOTAL DISBURSEMENTS THIS PERIOD d. BALANCE ON HAND (12.a. plus 12.b. minus 12.c.) 2 3 4•• $ 10 e. TOTAL LOANS OUTSTANDING RECHIVET}......... eS~............................... $ 4'r Y~........ ...~Uh $ f. TOTAL OBLIGATIONS OUTSTANDING .....2.2016 r. . r ~ O Page 1 of RDA y 1159 SS-1109 (Rev. 2/06) 9 SUMMARY PAGE - CANDIDATE 13. NAME OF CANDIDATE OR COMMITTEE (In Full) 14. REPO T OVERING T E ERIOD FROM: T0: RECEIPTS 15. CONTRIBUTIONS (other than loans and interest) a. Unitemized Contributions $100 or less from each source this period) b. Itemized Contributions (over $100 from each source this period) c. TOTAL CONTRIBUTIONS (other than loans and interest)(add 15.a. and 15.b.) $ 16. LOANS RECEIVED THIS REPORTING PERIOD 17. INTEREST RECEIVED THIS REPORTING PERIOD $ 18. TOTAL RECEIPTS (add 15.c., 16., and 17.) (must be shown in item 12.b.) vJ DISBURSEMENTS 19. EXPENDITURES (other than loan payments) a. Expenditures ($100 or less each payee this period) (must be listed by category - e.g., printing, postage, gasoline) $0 . 41 tw $ Jd $ $ $ Total of Expenditures ($100 or less each payee) $ b. Itemized Expenditures Over $100 each payee this period) $ SO. c. TOTAL EXPENDITURES other than loan re a ments add 19.a. and 19.b. $ 20. LOAN REPAYMENTS MADE THIS PERIOD $ O 21. TOTAL DISBURSEMENTS add 19.c. and 20. must be shown in item 12.c. $ 22.IN-KIND CONTRIBUTIONS a. Unitemized in-kind contributions ($100 or less from each source this period) $ b. Itemized in-kind contributions over $100 from each source this period) c. TOTAL IN-KIND CONTRIBUTIONS RECEIVED THIS PERIOD add 22.a. and 22.b. $ ✓ 23. OBLIGATIONS a. Unitemized Obligations Outstanding ($100 or less each) $ b. Itemized Obligations Outstanding Over $100 each $ c. TOTAL OBLIGATIONS OUTSTANDING (add 23.a. and 23.b.) (must be shown i item 12.f.) $ of "i~ ~i SS-1133 (Rev. 4102) Page CAMPAIGN FINANCIAL DISCLOSURE STATEMENT For State and Local Candidates For Single-Candidate Committees 1. DATE OF POR 2.a. NAME OF CANDIDATE OR COMMITTEE '24 l ti Ycj 2.b. IF COMMITTEE, NAME OF CANDIDATE 3. ELECTION DATE 4.a. CAMPAIGN ADDRtaa nwu, Street or Rural Route City State Zi Code Phone bQ'q UniU~~ ~ ~(0)A 3~1"1v1 ~'Gv 9 Nz ~3 9 4.b. CANDIDATE'S HOME ADDRESS (if different than 4.a.) Street or Rural Route City State Zip Code Phone 5. OFF ;CE SOUGHT (include dis ict number, if applicable) T66.. NAME OF POLITICAL TREASURER (may be candidate) 1.6vhrnkss i-~ n. 2 rn, Lt-Prr-p 7. CATEGORY OR REPORT (Check one) ❑ ❑ ❑ ❑ FIRST SECOND THIRD FOURTH PRE- PRE- MID-YEAR YEAR-END QUARTER QUARTER QUARTER QUARTER PRIMARY GENERAL SUPPLEMENTAL SUPPLEMENTAL 8.a. BEGINNING DATE OF REPORTING PERIOD 8.b. ENDING DATE OF REPORTING PERIOD 9. (Check one) a. ❑ This campaign is exempt from detailed disclosure because contributions (including in-kind) received total $1,000 or less AND expendi- tures total $1,000 or less for this reporting period. (Complete items 12d., 12e. and 12f.) b. This campaign is required to file a detailed financial disclosure because contributions (including in-kind) received total more than $1,000 and/or expenditures total more than $1,000 for this reporting period. 10. I/we do solemnly swear affirm th information contained in this campaign financial disclosure report is true and that this report is an accu to accounting of c p ' contribute ns and expenditures required to be re orted by the ca id a committee by the Campaign Fin ial Disclo re Act. d itionally, I/we swear or affirm that no campaign cont buti ns ve be n be a of the c didate r o n other n pended for the personal financial y political urpose as defined by the fe ral int I rev u o ' n ure of candidate at~ 4date ature f po itical tr surer 11. ITNESS SIGNATI IRE signature of witness date signature of witness tl 1 12. SUMMARY a. BALANCE ON HAND LAST REPORT $ (JU b. TOTAL RECEIPTS THIS PERIOD...... $ U o 1) c. TOTAL DISBURSEMENTS THIS PERIOD $ 4,q 1 sg d. BALANCE ON HAND (12.a. plus 12.b. minus 12.c.) PM 1• ~ Z e. TOTAL LOANS OUTSTANDING ..,ti. $ ; f. TOTAL OBLIGATIONS OUTSTANDING on ..a.. $ r9 SS-1109 (Rev. 2/06) 1ST Page 1 oft RDA 1159 ~ ~ wd wa SUMMARY PAGE - CANDIDATE 13. NAME O CA DIDATE OR C MITTEE (In Full) 14. RE O T COVERING E P RIOD '0 FROM I ' f T0: -L.1 RECEIPTS 15. CONTRIBUTIONS (other than loans and interest) a. Unitemized Contributions ($100 or less from each source this period) $ b. Itemized Contributions (over $100 from each source this period) $ c. TOTAL CONTRIBUTIONS (other than loans and interest)(add 15.a. and 15.b.) $ 16. LOANS RECEIVED THIS REPORTING PERIOD $ 17. INTEREST RECEIVED THIS REPORTING PERIOD ' RECEIPTS (add 15.c., 16., and 17.) (must be shown in item 12.b.) $ 18rSBURRSEMENTS ITURES (other than loan payments) a. Expenditures ($100 or less each payee this period) (must be listed by category - e.g., printing, postage, gasoline) AiLe s $ " oa Total of Expenditures ($100 or less each payee) $ b. Itemized Expenditures (Over $100 each this 2 payee period) s-45 c. TOTAL EXPENDITURES (other than loan repayments)(add 19.a. and 19.b.) $ 20. LOAN REPAYMENTS MADE THIS PERIOD $ 21. TOTAL DISBURSEMENTS (add 19.c. and 20.) (must be shown in item 12.c.) $ 22.1N-KIND CONTRIBUTIONS a. Unitemized in-kind contributions ($100 or less from each source this period) $ b. Itemized in-kind contributions (over $100 from each source this period) $ c. TOTAL IN-KIND CONTRIBUTIONS RECEIVED THIS PERIOD (add 22.a. and 22.b.) $ 23. OBLIGATIONS a. Unitemized Obligations Outstanding ($100 or less each) $ b. Itemized Obligations Outstanding (Over $100 each) $ c. TOTAL OBLIGATIONS OUTSTANDING (add 23.a. and 23.b.) (must be shown i item 121.) $ AM6 SS-1133 (Rev. 4/02) Page ~ of ITEMIZED STATEMENT OF CONTRIBUTIONS - CANDIDATE 1. NAME10F CAN IDAT OR COMMI E 2. REPOT VERING THE RIO C FROM: i ( TO: /lit f, Amount 3. TOTAL ITEMIZED CAMPAIGN CONTRIBUTIONS FROM PRECEDING PAGE (enter $0 if first itemized page) 4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED CONTRIBUTION (contributions totalin more than $100 from an contributor) First Name Middle N e Contribution Received For: Amount of Contribution Last Name/Organi tion Name 'N$-Primary Election ❑ General Election Jd D jJV~ Address ❑ Runoff (Local Elections Only) Ciry ,G~r Ll Vv, IS I Zj9n/\, Date of Contribution Aggregate This Election Occupation Y- a/1 `k ' SDDD - Employer ►Ik A4-4D Ca First Name 7 Middle Name Contribution Received For: Amount of Contribution Last Name/Organization Name ❑ Primary Election ❑ General Election Address ❑ Runoff (Local Elections Only) City State Zip Code Date of Contribution Aggregate This Election Occupation Employer First Name iddle Name Contribution Received For: Amount of Contribution as Name/Organization Name ❑ Primary Election ❑ General Election Address ❑ Runoff (Local Elections Only) City State Zip Code Date of Contribution Aggregate This Election Occupation Employer First Name Middle Name Contribution Received or. mount o Contribution Last Name/Organization Name ❑ Primary Election ❑ General Election Address ❑ Runoff (Local Elections Only) Ciry State Zip Code Date of Contribution Aggregate This Election Occupation Employer 5. TOTAL ITEMIZED CONTRIBUTIONS _ (Carry forward to item 3. of next page if additional pages of this form are used.) 1J Ua U O_ (If this is the last page of contributions, this amount must be shown in item 15b. of summary.) SS-1131(Rev. 2/06) Page J of RDA 1159 J ITEMIZED STATEMENT OF EXPENDITURES - CANDIDATE 1. NAME OF CANDIDATE OR COMMITTEE 2. REPOT OVERING THE ERIO MOca- FROM: t 1 TO: ~I ~i01 Amount M 3. TOTAL ITEMIZED CAMPAIGN EXPENDITURES FROM PRECEDING PAGE (enter $0 if first itemized page) 4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED EXPENDITURE (expenditures totaling more than $100 to any payee during the period) First Name Middle Name Purpose of Expenditure _ Amount of Expenditure Last NamelBusine,ss~~Name CI r c -I I L t-fV e Y4_1 S (0 S I Address City Slate Zip Code First Name Middle Name Purpose of Expenditure Amount of Expenditure Last Name/Business Name P r 1 n~ t ~s33~ S3 V P X1/1 ~r- L+ P Address Y u ~ Q C City State Zip Code First Name Middle Name Purpose of Expenditure Amount of Expenditure ast Name/ usiness Name L ~V~o(.~ Address City State Zip Code First Name Middle Name Purpose of Expenditure Amount of Expenditure Last Name/Business Name Address City State Zip Code First Name Middle Name Purpose of Expenditure Amount of Expenditure Last Name/Business Name Address City State Zip Code First Name Middle Name Purpose of Expenditure Amount of Expenditure Last Name/Business Name Address City State Zip Code 5. TOTAL ITEMIZED EXPENDITURES Cfi''L (Carry forward to item 3. of next page if additional pages of this form are used.) (If this is the last page of expenditures, this amount must be shown in item 19b. of summary.) SS-1129 (Rev. 4/02) Page of RDA 1159 ITEMIZED STATEMENT OF OBLIGATIONS - CANDIDATE 1, NAME OF CANDIE3AIE OR COMMITTEE 2. REPOR COVERING )HE PERIOD FROM: TO: 3. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED Outstanding Balance Debt Incur d ayments Outstanding Balance OBLIGATION (obligations totaling more than $100 owed to any (Beginning of Period) This Period This Period (End of Period) person/vendor at the end of the reporting period) First Name Middle Name 00 Last Name/Business Name Address ~V City State Zip Code Description of Obligation -YD IA C. P t7 U Q -Y 1 L b` Z First Name Middle Name Last Name/Business Name Address City State Zip Description of Obligation r. First Name Mi Name Last Name/Business Name Address City State Zip Code Description of Obligation First Name Middle Name Last Name/Business N Address City State Zip Code D ription of Obligation First Name Middle Name Last Name/Business Name Address City State Zip Code Description of Obligation 4.TOTALS (Total from Outstanding Balance - (End of Period) column must also be shown in item 23b. on summary page.) SS-1127 (Rev. 4102) Page of RDA 1159 r CAMPAIGN FINANCIAL DISCLOSURE STATEN' For State and Local Candidates E 1 • DATE OF EPOR For Single-Candidate Committees ' 12.a. NA (DATE OR ITTEE ~ 2.b. IF CO MI NAME OF CANDIDATE / l~ 3 D PNE • ELECTI DATE 4.a. CAMPAIGN ADDRE HO SA Stre or ural Route r 12i~/f I ~ ity ~1 7 f 0 r~~4 State Zip Code 4.b. CANDIDATE'S HOME ADDRESS (if different than 4.a. C Phone treet or ural to fT City fJ /11 - State Zip Code 5. OFFICE SOUGHT (include di ict number, if applicable) ti Z~ 7 Phone NAME OF P TIr,AL THE SUR 7• CATEGORY OR REPORT (Check one)(may be candidate) [R/ I FIRST 0 QUA RT SECOND THIRD FOURTH 8.a. BEGIN G ARTER UARTER a El PRE- DAT F REPORTING PERIOD QUARTER PRIMARY MID-YEAR 8.b. ENDINGDAGENERAL SUPPLEMENTAL YEAR❑-END FREP RTINGPERIOD SUPPLEMENTAL 9. (Chec ne) 3 31 tures a. his campaign is exempt from detailed disclosure because contributions (including in-kind) received total tures total $1,000 or less for this reporting period. (Complete items 12d., 12e. and 12f.) $1,000 or less AND expendi- ❑ This campaign is required to file a detailed financial disclosure because contributions (including in-kind and/or expenditures total more than $1,000 for this reporting period. received total more than $1,000 10. I/we do solemnly swear or affirm that the information contained in this campaign financial disclosure report is true and accurate account"19 of campaign contributions and expenditures required to be reported by t e cani ate committee by the Campaign Financi Oisclos ct. Additionally, I/we swear d or a irm t at no campaign contributions a bee a ended for the personal his report is an be ft the to or for any her nonpolitical p rrPos m as defined by the federal ' ~ Ire a ode. fina~ at re o ndidate a s, re litical treasurer do e 11. WITNESS SIGNATURE signature of wit date a-L~ signature o Hess date e 12. SUMMARY a. BALANCE ON HAND LAST REPORT N., ~ f`l $ b. TOTAL RECEIPTS THIS PERIOD ',SGV_N Ep ....try.............................................. $ C. TOTAL DISBURSEMENTS THIS PERIOD Q Q' V d. BALANCE ON HAND (12.a. plus 12.b. minus 12 c )C s_,.. 50 PfTOTA LOANS OUTSTANDING $ OBLIGATIONS OUTSTANDING D - SS-1109 (Rev. 2/06) Page 1 of ~ RDA 1159 CAMPAIGN FINANCIAL DISCLOSURE STATEMENT For State and Local Candidates For Single-Candidate Com ittees 1. DATE OFR RT 2.a. NAMEOF DI ATEOR MITT 2.b. IF COMMITTEE, NAME OF CANDIDATE 3. ELEC/Tj19u N DATE D g 4.a. CAMPAIGN ADDRESS AND PHONE Stre or Rural Route I City State Zip Code Phone C~ 9 n, vo Q ( /4/ co `7 4.b. CANDIDATE'S HOM AID SS (if different than 4.a.) Street or Rural oute City State Zip Code Phone 1 6k) D~ ( C-ou ~-N -776 5. OFFIC OUGHT (include dis ct n ber, if applicable) 6. NAME OF POLITIC L TREA URER ( ay be candidate) 1-6 irw 7. CATEGORY OR REPORT (Check one)❑ ❑ ❑ ❑ ❑ d FIRST SECOND THIRD FOURTH PRE- PRE- MID-YEAR YEAR-END QUARTER QUARTER QUARTER QUARTER PRIMARY GENE SUPPLEMENTAL SUPPLEMENTAL 8.a. BEGINNING DATE OF RE 7G PERIOD 8.b. ENDINGDATEOF PORTING PERIOD 7 a / f 1 9. (Check one a. This campaign is exempt from detailed disclosure because contributions (including in-kind) received total $1,000 or less AND expendi- tures total $1,000 or less for this reporting period. (Complete items 12d., 12e. and 12f.) b. ❑ This campaign is required to file a detailed financial disclosure because contributions (including in-kind) received total more than $1,000 and/or expenditures total more than $1,000 for this reporting period. 10. I/we do solemnly swear or affirm that the information contained in this campaign financial disclosure report is true and that this report is an accurate accounti of m aign contributions and expenditures required to be reported by the cWIdidate mmittee by the Campaign Financial Dis o e A ditionall swear or affirm t at no campaign contributions h e en ex ed for th sonal fina cial benefit of th ida r an ther onpolitical p rpos as defined by the federal inter I en l 31 I /1 If 1 ~f / signs re of rti i ate date sig 4 'of p if I treasurer dat 11. WITNESS SIGNATU date to date 12. SUMMARY -3 50 a. BALANCE ON HAND LAST REPORT ....................................,..x..20 j~ $ r_ b. TOTAL RECEIPTSTHIS PERIOD $ c. TOTAL DISBURSEMENTS THIS PERIOD d. BALANCE ON HAND (12.a. plus 12.b. minus 12.c.) $ e. TOTAL LOANS OUTSTANDING $ f. TOTAL OBLIGATIONS OUTSTANDING $ 4) SS-1109 (Rev. 2/06) Page 1 of 1 RDA 1159 f CAMPAIGN FINANCIAL DISCLOSURE STATEMENT For State and Local Candidates For Single-Candidate Committees 1. DATE OF REPORT 2.a. NAME OF ANDI T OR MMITTEE 2.b. IF COMMITTEE, NAME OF CANDIDATE 3. ELE TION i [ k Q'n 4.a. CAMPAIGN ADDRESS AND PHONE Street or Rural Route City State Zip Code Phone 4.b. CANDIDATE' H OWE ADDRESS if different than 4.a.) Stale n 1 Zip Code O Phor}~ Street or Rural R e 7N 5. OFFICE SOUGHT (include dist ct number, if applicable) 6. NAME OF POLITICAL REASUE2ER (may be candidate) G ~ Ir a ❑ ❑ ❑ y/ ❑ 7. CATEGORY OR REPORT (Check one) FIRST SECOND THIRD FOURTH PRE- PRE- MID-YEAR YEAR-END QUARTER QUARTER QUARTER QUARTER PRIMARY GENE SUPPLEMENTAL SUPPLEMENTAL 8.a. BEGINNING ATE REPORTING PERIOD 8.b. ENDING DA OF ING PERIOD t ~e ( .107 9.(Check one a. This campaign is exempt from detailed disclosure because contributions (including in-kind) received total $1,000 or less AND expendi- tures total $1,000 or less for this reporting period. (Complete items 12d., 12e. and 12f.) b. ❑ This campaign is required to file a detailed financial disclosure because contributions (including in-kind) received total more than $1,000 and/or expenditures total more than $1,000 for this reporting period. 10. I/we do solemnly swear or affirm that the information contained in this campaign financial disclosure report is true and that this report is an accurate accou ing of ampaign contributions and expenditures required to be reported by a candidate mmittee by the Campaign Financial sc ure A ddition I/we swear or affir that no campaign contributions een exp n d for the personal financial benefit o ndida r or an oth r nonpolitical urp se as defined by the federal int r enue c d . signs ure of n ids a at s na liti treasurer ate 11. WITNESS SIGNATURE signature of witness date signature of witness date 12. SUMMARY a. BALANCE ON HAND LAST REPORT $ f b. TOTAL RECEIPTSTHIS PERIOD 3 oa c. TOTAL DISBURSEMENTS THIS PERIOD $ d. BALANCE ON HAND (12.a. plus 12.b. minus 12.c.) r.. $ e. TOTAL LOANS OUTSTANDING $ T~' REGEi~ ~ © ✓ f. TOTAL OBLIGATIONS OUTSTANDING a $ N%. Jill 7 SS-1109 (Rev. 2106) Bo LmnoN y Page 1 of I RDA 1159 CAMPAIGN FINANCIAL DISCLOSURE STATEMENT For State and Local Candidates For Single-Candidate Committees 1. DATE OF REP RT _ 12.a. NAME OF q DIDATE C 1 2.b. IF COMM TT E, NAME OF CANDIDATE 3. ELECT N DA;E~ 4.a. CAMPAIGN ADDRESS AND PHO E Street or Rural R to City State Zip Code Phone Q IL 4.b. C ND DA E'S O E ADDRESS (if different than 4.a.) Street or Rural Route Ci State Zip Code Phone i d.D [ C'o zu -1-N i 72~1 0~ u URER (may be ca ndidate) 5. OFFICE SOUGHT (includ district number, i applicable) 6. NAME (LITIX;~ Ill rte V I'/,~/I 7. CATEGORY OR REPORT (Check one) ❑ ❑ ❑ ❑ ❑ ❑ ❑ FIRST SECOND THIRD FOURTH PRE- PRE- MID-YEAR YEAR-END QUARTER QUARTER QUARTER QUARTER PRIMARY GENERAL SUPPLEMENTAL SUPPLEMENTAL 8.a. BEGINNING DATE REP TING PERIOD 8.b. ENDING DA F REPO ING PERIOD 1 (0 0 2c~ 1S 9. (Check one) a. his campaign is exempt from detailed disclosure because contributions (including in-kind) received total $1,000 or less AND expendi- tures total $1,000 or less for this reporting period. (Complete items 12d., 12e. and 12f.) b. ❑ This campaign is required to file a detailed financial disclosure because contributions (including in-kind) received total more than $1,000 and/or expenditures total more than $1,000 for this reporting period. 10. I/we do solemnly swe or affirm that the information contained in this campaign financial disclosure repo is true and that this report is an accurate unting ampaign contributions and expenditures required to be reported by the c didate mittee by the Campaign Financi i clos Additiona we swear or aff at no campaign contribution v en died for the onalfinanci be f >he at or for a oth r nonpolitical p o as defined by the federal in r en de. 7i I~ y~SS L -ul tur of candidate da signature of po ical treasurer date 11. WITNESS SIGNATURE signature of witness date signature of witness date 12. SUMMARY a. BALANCE ON HAND LAST REPORT $ 1o i f v b. TOTAL RECEIPTSTHIS PERIOD c. TOTAL DISBURSEMENTS THIS PERIOD $ O ; O d. BALANCE ON HAND (12.a. plus 12.b. minus 12.c.) $ e. TOTAL LOANS OUTSTANDING ..................................C' 11~ $ f. TOTAL OBLIGATIONS OUTSTANDING $ J11C° ) BLOL 'go OUIhy N SS-1109 (Rev. 2/06) ELE W Page 1 of RDA 1159 l~ G 8 4 CAMPAIGN FINANCIAL DISCLOSURE STATEMENT For State and Local Candidates For Single-Candidate Committees T 2.a. NAME OF CANDID E OR COM ITTEE 1. DATMOMMIEE 2.b. IF C , , NAME OF CANDIDATE 3. ELEC ION DATE 4.a. CAMPAIGN ADDRESS AND PHONE 'jet Street or Rural Rou `City State Zip Code Phone Q 4.b. CANDIDATE'S HOME ADDRESS (if different than 4.4 Street or Rural Route ity State Zip Code Phone 5. OFFICE SOUGHT (include district number, if applicable) 6. NAME OF POLITICAL T EASURER (may be candidate) 7. CAFE❑GO YOR RE O~ (Check one) FIRST SECOND TH13 IRD FOURTH E PRE- Q _ QUARTER QUARTER QUARTER QUARTER PRIMARY GE ERAL SUPPLEMENTAL MID-YEAR SUPPLEMENTAL 8.a. BEGINNING DA OF EPORTING PERIOD 8.b. ENDING ATE F RRIE.PORTING PERIOD 9. (Check one) ' v a. This campaign is exempt from detailed disclosure because contributions (including in-kind) received total $1,000 or less AND expendi- tures total $1,000 or less for this reporting period. (Complete items 12d., 12e. and 12f.) b. This campaign is required to file a detailed financial disclosure because contributions (including in-kind) received total more than $1,000 and/or expenditures total more than $1,000 for this reporting period. nly swe or affirm that the information contained in this campaign financial disclosur report is true and that this report is an ing o mpaign contributions and exp itures required to be reported y can ate committee by the C poi n re ddition Ily, I/we swear r affir that no campaign contributio a be e ,,ended r the person I fna cial dida o ran o her nonpolitic purpo a as defined by the federal in reve a de. of candi a da a gnature of politi al treasurer ate . NATURE ESIGNATURE sign ature of witness date signature of witness I 7da 12. SUMMARY a. BALANCE ON HAND LAST REPORT $ b. TOTAL RECEIPTS THIS PERIOD I c. TOTAL DISBURSEMENTS THIS PERIOD 0 d. BALANCE ON HAND (12.a. plus 12.b. minus 12.c.) ) I V e. TOTAL LOANS OUTSTANDING " V f. TOTAL OBLIGATIONS OUTSTANDING O _ 4) SS-1109 (Rev. 2/06) Page 1 of "I RDA 1159 SUMMARY PAGE - CANDIDATE 13. NAME OF CANDIDATE OR CO MITTE~(In Full) 14. REPOE~j C VERING TH PE IOD (l \v FROM: p I`E TO: RECEIPTS 15. CONTRIBUTIONS (other than loans and interest) a. Unitemized Contributions ($100 or less from each source this period) $ b. Itemized Contributions (over $100 from each source this period) $ If5l. 5+ CIS c. TOTAL CONTRIBUTIONS (other than loans and mterest)(add 15.a. and 15.b.) $ 16. LOANS RECEIVED THIS REPORTING PERIOD 17. INTEREST RECEIVED THIS REPORTING PERIOD $ L ~l 18. TOTAL RECEIPTS (add 15.c., 16., and 17.) (must be shown in item 12.b.) $ DISBURSEMENTS 19. EXPENDITURES (other than loan payments) a. Expenditures ($100 or less each payee this period) (must be listed by category - e.g., printing, postage, gasoline) Total of Expenditures ($100 or less each payee) $ b. Itemized Expenditures (Over $100 each payee this period) $ c. TOTAL EXPENDITURES (other than loan repayments) (add 19.a. and 19.b.) $ 20. LOAN REPAYMENTS MADE THIS PERIOD $ r- Q r 21. TOTAL DISBURSEMENTS (add 19.c. and 20.) (must be shown in item 12.c.) $ 22.IN-KIND CONTRIBUTIONS a. Unitemized in-kind contributions ($100 or less from each source this period) $ b. Itemized in-kind contributions (over $100 from each source this period) $ r J c. TOTAL IN-KIND CONTRIBUTIONS RECEIVED THIS PERIOD (add 22.a. and 22.b.) $ 23. OBLIGATIONS a. Unitemized Obligations Outstanding ($100 or less each) $ b. Itemized Obligations Outstanding (Over $100 each) $ J c. TOTAL OBLIGATIONS OUTSTANDING (add 23.a. and 23.b.) (must be shown i item 121) $ SS-1133 (Rev. 4102) Page O of ITEMIZED STATEMENT OF CONTRIBUTIONS - CANDIDATE 1. NAME OF CAN (DATE 0 OMM E 2. REPORT ERING THE P RIOD FRO TO: 3. TOTAL ITEMIZED CAMPAIGN CONTRIBUTIONS FROM PRECEDING PAGE (enter $0 if first itemized page) Amount 4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED CONTRIBUTION (contributions totaling more than $100 from an contributor , First Name Middle Na Contribution Received For. Amount of Contribution Last Name 0 ization N e ❑ Primary Election General Election C Address ~ I J ❑ Runoff (Local Elections Only) City state ) Zip Code Date of Contributio Aggregate This Election Occupatiory-.e~ G r 1 l~ a I Employer C~ First Name Middle Name Contribution Received For: Amount of Contribution Last Name/Organization Name ❑ Primary Election ❑ General Election Address ❑ Runoff (Local Elections Only) City State Zip Code Date of Contribution Aggregate This Election Occupation Employer First Name iddle Name Contribution Received For: Amount of Contribution as ame rganrza on Name ❑ Primary Election ❑ General Election Address ❑ Runoff (Local Elections Only) City state Zip Code Date of Contribution Aggregate This Election Occupation Dyer First Name Middle Name Contribution ecetve or: mount o Contn ution Last Name/Organization Name ❑ Primary Election ❑ General Election Address ❑ Runoff (Local Elections Only) City state Zip Code Date of Contribution Aggregate This Election Occupation Employer 5. TOTAL ITEMIZED CONTRIBUTIONS n (Carry forward to item 3. of next page if additional pages of this form are used.) f / (If this is the last page of contributions, this amount must be shown In Item 15b. of summary.) I 7 SS-1131(Rev. 2/06) Page of RDA 1159 ITEMIZED STATEMENT OF IN-KIND CONTRIBUTIONS - CANDIDATE 1. NAME OF CANDID OFD COMMIE E 2. REPORT C RING THE P 10 FROM: A 141A T0: mou t 3. TOTAL ITEMIZED IN-KIND CONTRIBUTIONS FROM PRECEDING PAGE (enter $0 if first itemized page) 4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED IN-KIND CONTRIBUTION (in-kind contributions totaling more than $100 from any contributor during the period) First Name Middle Name In-Kind Contribution Received For: Value of In-Kind Contribution ❑ Primary Election ❑ General Election Last NamelOrganization Name ❑ Runoff (Local Elections Only) Address Dale of In-Kind Contribution Aggregate this Election City State Zip Code Description of In-Kind Contribution Occupation Employer First Name Middle Name In-Kind Contribution Received For: Value of In-Kind Contribution ❑ Primary Election ❑ General Election Last Name/Organization Name ❑ Runoff (Local Elections Only) Address Date of In-KGnd Contribution Aggregate this Election City State Zip Code Description of In-Kind Contribution Occupation Employer First Name Middle Name In-Kind Contribution Received For: Value of In-Kind Contribution ❑ Primary Election ❑ General Election Last NamelOrganization Name ❑ Runoff (Local Elections Only) Address Date of In-IGnd Contribution Aggregate this Election City State Zip Code Description of In-IGnd Contribution Occupation Employer First Name Middle Name In-Kind Contribution Received For: Value of In-Kind Contribution ❑ Primary Election ❑ General Election Last Name/Organization Name ❑ Runoff (Local Elections Only) Address Date of In-Kind Contribution Aggregate this Election City State Zip Code Description of In-Kind Contribution Occupation Employer First Name Middle Name In-Kind Contribution Received For: Value of In-Kind Contribution ❑ Primary Election ❑ General Election Last Name/Organization Name ❑ Runoff (Local Elections Only) Address Date of InXind Contribution Aggregate this Election City State Zip Cade Description of In-Kind Contribution ccupa ion mpoyer 5. TOTAL ITEMIZED IN-KIND CONTRIBUTIONS O (Carry forward to item 3. of next page if additional pages of this form are used.) (If this is the last page of in-kind contributions, this amount must be shown in item 22b. of summary.) - SS-1128 (Rev. 2106) Page of RDA 1159 ITEMIZED STATEMENT OF EXPENDITURES - CANDIDATE 1. NAME OF CAN I R COM I T1EF~ V 2. RT; HE P IOD ~ 3. TOTAL ITEMIZED CAMPAIGN EXPENDITURES FROM PRECEDING PAGE (enter $0 if first itemized page) n 4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED EXPENDITURE (expenditures totaling more than $100 to any payee during the period) First Name Middle Name Purpose of Expenditure Amount of Expenditure Last NamelBusiness Name Address City State Zip Code First Name Middle Name Purpose of Expenditure Amount of Expenditure Last Name/Business Name Address City State Zip Code First Name Middle Name Purpose of Expenditure Amount of Expenditure Last Name/Business Name Address City State Zip Code First Name Middle Name Purpose of Expenditure Amount of Expenditure Last Name/Business Name Address City State Zip Code First Name Middle Name Purpose of Expenditure Amount of Expenditure Last Name/Business Name Address city State Zip Code First Name Middle Name Purpose of Expenditure Amount of Expenditure Last NamelBusiness Name Address City State Z5. TOTAL ITEMIZED EXPENDITURES (Carry forward to item 3. of next page if additional pages of this form are used.) Q (If this is the last page of expenditures, this amount must be shown in item 19b. of summary.) 5S-1129 (Rev. 4/02) Page ~ of ~ RDA 1159 ITEMIZED STATEMENT OF LOANS - CANDIDATE 1. NAME OF CANDIDATE OR COM TEE 2. REPORT COVERING THE RIO no ~ FROCI:d1 T0:11~- 3. COMPLETE TH APPROPRIATE ITEMS FOR EACH ITEMIZED LOAN (loans totaling more than $100 from any source during the period) Complete the Following for the Source of the Loan First Name Middle Name Outstanding Loan Balance Loans Loan Outstanding Loan Balance (Beginning of Period) Received Payments (End of Period) Last Name/Organization Name Address Loan Received For: Date of Loan ❑ Primary Election ❑ General Election City State Zip Code I ❑ Runoff (Local Elections Only) List All Endorsers or Guarantors for Above Loan (If more space is needed please attach a page) Middle Name First Name Middle Name First Name Last NamelOrganization Name Last Name/Organization Name Address Address City State Zip Code city State Zip Code Amount Guaranteed Outstanding Amount Guaranteed Outstanding Middle Name First Name Middle Name First Name Last Name/Organization Name Last Name/Organization Name Address Address City State Zip Code city State Zip Code Amount Guaranteed Outstanding mount Guaranteed Outstanding First Name Middle Name First Name Middle Name Last Name/Organization Name Last Name/Organization Name Address Address City Slate Zip Code City State Zip Code Amount Guaranteed Outstanding Amount Guaranteed Outstanding First Name Middle Name First Name Middle Name Last NamelOrganization Name Last Name/Organization Name Address Address State Zip Code City State Zip Code city Amount Guaranteed Outstanding mount Guaranteed Outstanding 4. Totals for all Loans (complete on last page of Itemized loans) Outstanding Loan Balance Loans Loan Outstanding Loan Balance (Total loans received should also be shown in item 16. on summary page.) Be innin of Per od Received Payments (End of Period (Total loan payments should also be shown in item 20. on summary page.) (Total outstanding loan balance should also be shown in item 12.e. on front page.) SS-1132 (Rev. 4102) Page of RDA 1159 Afilh, ITEMIZED STATEMENT OF OBLIGATIONS - CANDIDATE 1. NAME OF CANDIDAT MMITTEE 2. REPORT C E ING THE PERIOD _V1 A A, FROM: J L) TO: 3. COMPLETE THE APPROPRIATE ITEMS FO EAC ITEMIZED Outstanding Balance Debt Incurred payments Ott standil g Balance OBLIGATION (obligations totaling more than $100 owed to any (Beginning of Period) This Period This Period (End of Period) person/vendor at the end of the reporting period) First Name Middle Name Last Name/Business Name Address city State Zip Code Description of Obligation Flrst Name Middle Name Last Name /Business Name Address City State Zip Code Description of Obligation Flrsl Name Middle Name Last Name/Business Name Address City State Zip Code Description of Obligation First Name Middle Name Last Name/Business Name Address City State Zip Code Description of Obligation First Name Middle Name Last Name/Business Name Address city State Zip Code Description of Obligation 4. TOTALS (Total from Outstanding Balance - (End of Period) column must also be shown . i 0.~ in Item 23b. on summary page.) Aft SS-1127 (Rev. 4/02) Page of RDA 1159 . h CAMPAIGN FINANCIAL DISCLOSURE STATEMENT For State and Local Candidates For Single-Candidate Co mittees 1. DATE O EPO T, 12.a. NAME F CANDIDATE R MMI EE 3. ELEtO DAT 2.b. IF CO MITT E, N ME OF CANDIDATE 4.a. CAMPAIGN ADDRESS AND PHONE r Stree or Rural Route city Statne) Zip Code Phone 4.b. CA A S HOME DDRESS (if different than 4 State Zip Code P ne Stree or Rural Routp) ~ City 5. OFF E SOUGHT (include distri number, if applicable) 6. NA E.OF OLITIC REASURER (may be candidate) _AA I I lit 7. CATEGOR O REPOR (Check one) FIRST SECOND THIRD FOU❑RTH PRE- PRE- MIDD❑YEAR YEAR-END QUARTER QU TER QUARTER QUARTER PRIMARY GENERAL SUPPLEMENTAL SUPPLEMENTAL 8.a. BEGINNING DA OF PORTING PERIOD 8.b. ENDING ATE u- PORTING PERIOD -7 ji,~q 9. (Check one) a. ❑ This campaign is exempt from detailed disclosure because contributions (including in-kind) received total $1,000 or less AND expendi- tures total $1,000 or less for this reporting period. (Complete items 12d., 12e. and 12f.) b. This campaign is required to file a detailed financial disclosure because contributions (including in-kind) received total more than $1,000 and/or expenditures total more than $1,000 for this reporting period. 10. I/we do solemn swear r affirm that the information contained in this campaign r o is true and that this report is an accuate ac ling of mpaign cc tributions and expenditures required to be cand' t mmittee by the Campaign Financial D' ure Ac ditinal Uwe swear or affir that no campaign coe bee ded a personal fi ciaLX_ benefit of idat any o nonpolitical urpo a as defined by the freve ignatur of candi to ate sig ure of politic I treasurer ate 11. WITNESS SIGNATURE signature of witness date signature of witness date 12. SUMMARY a. BALANCE ON HAND LAST REPORT $ V b. TOTAL RECEIPTSTHIS PERIOD OC~ c. TOTAL DISBURSEMENTS THIS PERIOD $ d. BALANCE ON HAND (12.a. plus 12.b. minus 12.c.) e. TOTAL LOANS OUTSTANDING $ f. TOTAL OBLIGATIONS OUTSTANDING $ SS-1109 (Rev. 2106) Page 1 of t~ RDA 1159 SUMMARY PAGE - CANDIDATE 13. NAME OF CANDIDATE R COMMI EE (I Full) :]]4. REPO T OVERING TH PE ID ITT, ROM: T0: RECEIPTS 15. CONTRIBUTIONS (other than loans and interest) a. Unitemized Contributions ($100 or less from each source this period) $ b. Itemized Contributions (over $100 from each source this period) $ y Q c. TOTAL CONTRIBUTIONS (other than loans and interest)(add 15.a. and 15.b.) $ 16. LOANS RECEIVED THIS REPORTING PERIOD $ _ 17. INTEREST RECEIVED THIS REPORTING PERIOD $ 18. TOTAL RECEIPTS (add 15.c., 16., and 17.) (must be shown in item 12.b.) $ DISBURSEMENTS 19. EXPENDITURES (other than loan payments) - e.g., printing, postage, gasoline) a. Expenditures ($100 or less each payee this period) (must be listed by category Total of Expenditures ($100 or less each payee) $ b. Itemized Expenditures (Over $100 each payee this period) $J c. TOTAL EXPENDITURES (other than loan repayments)(add 19.a. and 19.b.) $ 20. LOAN REPAYMENTS MADE THIS PERIOD $ o 21. TOTAL DISBURSEMENTS (add 19.c. and 20.) (must be shown in item 12.c.) $ 22.IN-KIND CONTRIBUTIONS J a. Unitemized in-kind contributions ($100 or less from each source this period) $ J b. Itemized in-kind contributions (over $100 from each source this period) $ c. TOTAL IN-KIND CONTRIBUTIONS RECEIVED THIS PERIOD (add 22.a. and 22.b.) $ 23. OBLIGATIONS a. Unitemized Obligations Outstanding ($100 or less each) $ b. Itemized Obligations Outstanding (Over $100 each) $ c. TOTAL OBLIGATIONS OUTSTANDING (add 23.a. and 23.b.) (must be shown i item 12.f.) $ i 45 SS-1133 (Rev. 4102) Page ofd ITEMIZED STATEMENT OF CONTRIBUTIONS - CANDIDATE 1. NAME OF CANDIDA OMMI 2. REPORT 0 RING THE P RIOD FROM: TO: ArnoLfrit' 3. TOTAL ITEMIZED CAMPAIGN CONTRIBUTIONS FROM PRECEDING PAGE (enter $0 if first itemized page) Q 4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED CONTRIBUTION (contributions totaling more than $100 from an contributor First Name Middle Name Contribution Received For: Amount of Contribution Last Name/Organization Name ❑ Primary Election ❑ General Election Address ❑ Runoff (Local Elections Only) City State Zip Code Date of Contribution Aggregate This Election Occupation Employer First Name Middle Name Contribution Received For: Amount of Contribution Last Name/Organization Name ❑ Primary Election ❑ General Election Address ❑ Runoff (Local Elections Only) City State Zip Code Date of Contribution Aggregate This Election Occupation Employer First Name IM iddle Name Contribution Received For: Amount of Contribution as Name/Organization Name ❑ Primary Election ❑ General Election Address ❑ Runoff (Local Elections Only) City State Zip Code Date of Contribution Aggregate This Election Occupation Employer First Name Middle Name Contribution Received or: mount of Contribution Last Name/OrganizationName ❑ Primary Election ❑ General Election Address ❑ Runoff (Local Elections Only) City State zlpCode Date of Contribution Aggregate This Election Occupation Employer 5. TOTAL ITEMIZED CONTRIBUTIONS (Carry forward to item 3. of next page if additional pages of this form are used.) (If this is the last page of contributions, this amount must be shown in item 15b. of summary.) 0) SS-1131(Rev. 2/06) Page of RDA 1159 ITEMIZED STATEMENT OF IN-KIND CONTRIBUTIONS - CANDIDATE 1. NAME OF CA TE OR COMMI 2. REPORT OVERING THE P MOD 1 FROM: T0: mount 3. TOTAL ITEMIZED IN-KIND CONTRIBUTIONS FROM PRECEDING PAGE (enter $0 if first itemized page) 4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED IN-KIND CONTRIBUTION (in-kind contributions totaling more than $100 from any contributor during the period) First Name Middle Name In-Kind Contribution Received For: Value of In-Kind Contribution ❑ Primary Election ❑ General Election Last Name/Organization Name ❑ Runoff (Local Elections Only) Address Date of In-Kind Contribution Aggregate this Election City State Zip Code Description of In-Kind Contribution Occupation Employer First Name Middle Name In-Kind Contribution Received For: Value of In-Kind Contribution ❑ Primary Election ❑ General Election Last Name/Organization Name ❑ Runoff (Local Elections Only) Address Date of In4,W Contribution Aggregate this Election City State Zip Code Description of In-Kind Contribution Occupation Employer First Name Middle Name In-Kind Contribution Received For: Value of In-Kind Contribution ❑ Primary Election ❑ General Election Last NamelOrganization Name ❑ Runoff (Local Elections Only) Address Date of In-Kind Contribution Aggregate this Election City State Zip Code Description of In-Kind Contribution Occupation Employer First Name Middle Name In-Kind Contribution Received For: Value of In-Kind Contribution ❑ Primary Election ❑ General Election Last Name/Organization Name ❑ Runoff (Local Elections Only) Address Date of In-Kind Contribution Aggregate this Election City State Zip Code Description of In-Kind Contribution Occupation Employer First Name Middle Name In-Kind Contribution Received For: Value of In-Kind Contribution LastNamelOrganization Name [3 Primary Election E] General Election ❑ Runoff (Local Elections Only) Address Date of In-Kind Contribution Aggregate this Election City State Zip Code Description of Iri-K ind Contribution Occupation Employer 5. TOTAL ITEMIZED IN-KIND CONTRIBUTIONS (Carryforward to item 3. of next page if additional pages of this form are used.) (If this is the last page of in-kind contributions, this amount must be shown in item 22b. of summary.) VV SS-1128 (Rev. 2/06) Page of RDA 1159 ITEMIZED STATEMENT OF EXPENDITURES - CANDIDATE 1. NAME OF CANDID p COM T E 2. REPOR CO RING THE RIO FROM TO: mW t 3. TOTAL ITEMIZED CAMPAIGN EXPENDITURES FROM PRECEDING PAGE (enter $0 if first itemized page) 4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED EXPENDITURE (expenditures totaling more than $100 to any payee during the period) First Name Middle Name Purpose of Expenditure Amount of Expenditure Last NamelBusiness Name Address City State Zip Code First Name Gz4, IV, Middle Name Purpose of Expenditure Amount of Expenditure Last NamelBusiness Name Address city State Zip Code First Nam Middle Name Purpose of Expenditure Amount of Expenditure Last Name/Business Name t Address City State Zip Code First Name Middle Name Purpose of Expenditure Amount of Expenditure Last Name/Business Name Address City State Zip Code First Name Middle Name Purpose of Expenditure Amount of Expenditure Last NamelBusiness Name Address City State Zip Code First Name Middle Name Purpose of Expenditure Amount of Expenditure Last Name/Business Name Address City State Zip Code 5. TOTAL ITEMIZED EXPENDITURES r~ (Carry forward to item 3. of next page if additional pages of this form are used.) (If this is the last page of expenditures, this amount must be shown in item 19b. of summary.) SS-1129 (Rev. 4102) Page r' of~ RDA 1159 VL ITEMIZED STATEMENT OF LOANS - CANDIDATE ERING THE RIOD O~~ MMIT F0 T0: FL3.COMPLETE E OF CA DI 2. RE RT THE APPROPRIATE ITEMS R ACH ITEMIZED LOAN (loans totaling more than $100 from any source uring th nod) Complete the Following for the Source of the Loan Loan Outstanding Loan Balance First Name Middle Name Outstanding Loan Balance Loans (Beginning of Period) Received Payments (End of Period) Last Name/Organization Name Loan Received For: Date of Loan Address ❑ Primary Election ❑ General Election City State Zip Code ❑ Runoff (Local Elections Only) List All Endorsers or Guarantors for Above Loan (If more space is needed please attach a page) Middle Name First Name Middle Name First Name Last Name/Organization Name Last Name/Organization Name Address Address State Zip Code Gty State Zip Code City Amount Guaranteed Outstanding Amount Guaranteed Outstanding Middle Name First Name Middle Name First Name Last Name/Organization Name Last Name/Organization Name Address Address State Zip Code City State Zip Code Gty Amount Guaranteed Outstanding mount Guaranteed Outstanding Middle Name First Name Middle Name First Name Last NamelOrganization Name Last Name/Organization Name Address Address State Zip Code Gty State Zip Code City Amount Guaranteed Outstanding Amount Guaranteed Outstanding Middle Name First Name Middle Name First Name Last Name/Organization Name Last Name/Organization Name Address Address State Zip Code Gty State Zip Code City Amount Guaranteed Outstanding Amount Guaranteed Outstanding 4. Totals for all Loans (complete on last page of itemized loans) Outstanding Loan Balance Loans Loan Outstanding Loan Balance (Total loans received should also be shown in item 16. on summary page.) (Beginning of Period Received Pa ments End of Period r (Total loan payments should also be shown in item 20. on summary page.) (Total outstanding loan balance should also be shown in item 12.e. on front page.) Page of RDA 1159 Aahk SS-1132 (Rev. 4102) M ITEMIZED STATEMENT OF OBLIGATIONS - CANDIDATE 1. NAME OF CANDIDATE ITTEE / 2. REPORT OVER G THE PERIOD > 1FROM: TO: 3. COMPLETE THE APP OPRIATE ITEMS FOR EACH ITEMIZED Outstanding Balance Debt Inc re ayments utsta ing Balance OBLIGATION (obligations totaling more than $100 owed to any (Beginning of Period) This Period This Period (End of Period) person/vendor at the end of the reporting period) Flrst Name Middle Name Last Name/Business Name Address city state Zip Code Description of Obligation First Name Middle Name Last Name/Business Name Address City State Zip Code Description of Obligation First Name Middle Name Last Name/Business Name Address city State Zip Code Description of Obligation Flrst Name Middle Name Last Name/Business Name Address City State Zip Code Description of Obligation First Name Middle Name Last Name/Business Name Address City State Zip Code Description of Obligation 4. TOTALS (Total from Outstanding Balance - (End of Period) column must also be shown 1 in item 23b. on summary page.) Aft SS-1127 (Rev. 4102) Page of RDA 1159 i CAMPAIGN FINANCIAL DISCLOSURE STATEMENT For State and Local Candidates For Single-Candidate Committees 1. DATE OF •REP RT 12.a. NAME O DIDATE O MMI E 2.b. IF COMM[ E, NA OF CANDIDATE 3. ELECTION AT 7 i 4.a. CAMPAIGN ADDRESS AND PHONE C ty Stree State Zip Code Phone ~ural Ro enu J~~/n~ 4.b. CANDIDATE'S HOME ADDRESS (if different than 4 a. State Zip Code Pfl efL ` S treet or Rural R to City _r NAME OF POLIT CAL T ASURER (may be candidate) 5. OFFICE SOUGHT (include di trict nutuber, if applicable)) 6. 7. CATEGORY OR REPORT (Check one) ❑ PRE- MIDD❑YEAR YEAR-END FIRST SECOND THIRD FOURTH PRE- QUARTER QUARTE QUARTER QUARTER PRIMARY GENERAL SUPPLEMENTAL SUPPLEMENTAL 8.a. BEGINNING DATE OF EP RTING PERIOD 8.b. ENDING DATE O REPOR ING PERIOD -7 9. (Check one) a. This campaign is exempt from detailed disclosure because contributions (including in-kind) received total $1,000 or less AND expendi- tures total $1,000 or less for this reporting period. (Complete items 12d., 12e. and 12f.) b. ❑ This campaign is required to file a detailed financial disclosure because contributions (including in-kind) received total more than $1,000 and/or expenditures total more than $1,000 for this reporting period. 10. l1we do solemnly swear or affirm that the information contained in this campaign financial disclosure report is true and that this report is an accurate acc g of camp g ont6b i s and expenditures required to be reported b e candid a mmittee by the Campaign Financial Di re Act. A o Ily, a wear or affir that no campaign contribution a been p nded for a personal fi ncial benefi f c idate or an oth non olitical pure sea defined by the federal i even e. 7 r~ d to signature of political treasurer date signature of candidate 11. WITNESS SIGNATURE ' Z I~( ~ zN ate signature of witness date nature of witness 12. SUMMARY a. BALANCE ON HAND LAST REPORT ~.~.3 .f 5 6 ,7.g'9 $ ~y ..fl........ $ b. TOTAL RECEIPTS THIS PERIOD N .....:..~....i...... ~ ~ ~ c. TOTAL DISBURSEMENTS THIS PERIOD .~......Q~ d. BALANCE ON HAND (12.a. plus 12.b. minus 12.c.) ii.. $ s 'y e. TOTAL LOANS OUTSTANDING . L..y..c~. a.... $ ~ cJ f. TOTAL OBLIGATIONS OUTSTANDING $ Page 1 of RDA 1159 SS-1109 (Rev. 2106) CAMPAIGN FINANCIAL DISCLOSURE STATEMENT For State and Local Candidates For Single-Candidate Committees 1. DATE OF REPOR I Q 12.a. NAME F C DIDATE R COM(NITTEE lK~f(f Z\J -7 2.b. IF COMMITTE NA E OF CANDIDATE 3. ELECTIO D T 4.a. CAMPAIGN ADDRESS AND PHONE Street or Rural Route City State Zip Code Phone a `I 4.b. CANDIDATE'S HOME ADDRESS (if different than 4.a.) Street or Rural Route City State Zip Code Phone ~-JD~ bl(a~ - 5. ~FICE SOUGHT (includ district number, if applicable) 6. NAME OF P LITICAL TREASURER (may be candidate) ' NVI r I so 7. CATEGORY OR RE RT,;Check one) FIRST SECO000" 1:1 ND THIRD FOURTH PRE- PRE- MID-YEAR YEAR-END QUARTER QUAR R QUARTER QUARTER PRIMARY GENERAL SUPPLEMENTAL SUPPLEMENTAL 8.a. BEGINNING DATE OF R ORTIN PERIOD 8.b. ENDING ATE F REPORTING PERIOD a 9. (Check one) pq a. ❑ This campaign is exempt from detailed disclosure because contributions (including in-kind) received total $1,000 or less AND expendi- tures total $1,000 or less for this reporting period. (Complete items 12d., 12e. and 12f.) b. Off4his campaign is required to file a detailed financial disclosure because contributions (including in-kind) received total more than $1,000 and/or expenditures total more than $1,000 for this reporting period. 10. 1/we do solemnly swear or affirm that the information contained in this campaign financial disclosure report is true and that this report is an accurate accounting of campaign contributions and expenditures required to be reported by the candidate committee by the Campaign Financial Disclosure Act. Additionally, I/we swear or affirm that no campaign contributions have been expended for the personal finan I benefit o th andi to r for an other nonpolitical Lpo a as defined by the federen de. at o a i to ignature of political treasurer d to 11. WITNESS SIGNATURE signature of witness date signature of witness date 12. SUMMARY I Jy~- a. BALANCE ON HAND LAST REPORT $ / I b. TOTAL RECEIPTS THIS PERIOD $ pqo w /✓p o, TOTAL DISBURSEMENTS THIS PERIOD $ /.J d. BALANCE ON HAND (12.a. plus 12.b. minus 12.c.) $ e. TOTAL LOANS OUTSTANDING $ b f. TOTAL OBLIGATIONS OUTSTANDING $ 45 SS-1109 (Rev. 2/06) Page 1 of RDA 1159 4 SUMMARY PAGE - CANDIDATE 13. NAME OF CANDID OR CO MITT (In Full) 14. REPO T COVERING T PERIOD FROM: TO: RECEIPTS 15. CONTRIBUTIONS (other than loans and interest) a. Unitemized Contributions ($100 or less from each source this period) $ b. Itemized Contributions (over $100 from each source this period) $ ~j c. TOTAL CONTRIBUTIONS (other than loans and interest)(add 15.a. and 15.b.) 16. LOANS RECEIVED THIS REPORTING PERIOD 17. INTEREST RECEIVED THIS REPORTING PERIOD 18. TOTAL RECEIPTS (add 15.c., 16., and 17.) (must be shown in item 12.b.) $ DISBURSEMENTS 19. EXPENDITURES (other than loan payments) a. Expenditures ($100 or less each payee this period) (must be listed by category - e. g., printing, postage, gasoline) Total of Expenditures ($100 or less each payee) yam, b. Itemized Expenditures (Over $100 each payee this period) 7S c. TOTAL EXPENDITURES (other than loan repayments)(add 19.a. and 19.b.) . 20. LOAN REPAYMENTS MADE THIS PERIOD $ 21. TOTAL DISBURSEMENTS (add 19.c. and 20.) (must be shown in item 12.c.) $ 22.IN-KIND CONTRIBUTIONS a. Unitemized in-kind contributions ($100 or less from each source this period) $ b. Itemized in-kind contributions (over $100 from each source this period) $ c. TOTAL IN-KIND CONTRIBUTIONS RECEIVED THIS PERIOD (add 22.a. and 22.b.) 23. OBLIGATIONS $ a. Unitemized Obligations Outstanding ($100 or less each) $ b. Itemized Obligations Outstanding (Over $100 each) $ c. TOTAL OBLIGATIONS OUTSTANDING (add 23.a. and 23.b.) (must be shown i item 12.f.) 0 SS-1133 (Rev. 4102) Page of c ITEMIZED STATEMENT OF CONTRIBUTIONS - CANDIDATE 1. NAME OF CANDIDATE OR COM 1:: 1: Im OVERI NG THE PE OD TO: Amount 3. TOTAL ITEMIZED CAMPAIGN CONTRIBUTIONS FROM PRECEDING PAGE (enter $0 if first itemized page) " 0 4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED CONTRIBUTION (contributions totaling more than $100 from an contributor Middle Na(r Contribution Received For: Amount of Contribution First Name Il~/1 Primary Election ❑ General Election Last Name/OrganizationN e 5 Address ❑ Runoff (Local Elections Only) City Date of Conlributio Aggregate This EI)e ion ~,J grar~(^ Zp Occupation Employer MiddleNar6e 771 Contribution Received For: Amount of Contribution First Name Last Name/Organiza'o N e CJPnmary Election ❑ General Election Address ❑ Runoff (Local Elections Only) p Date of Contribution Aggregate This %ction CRY Zip B OJi- Occupation \ 1 Employer iddleName Contribution Received For: Amount of Contribution TFirstNam rimary Election ❑ General Election rFizzoqnn e ~ . Address ❑ Runoff (Local Elections Only) r state Zip Code Date of Contribution Aggregate This Election city N Occupation m oyer Middle Name Contribution Received or: mount o Contribution First Name Last Name/Organization Name ❑ Primary Election ❑ General Election Address ❑ Runoff (Local Elections Only) State Zip Code Date of Contribution Aggregate This Election City Occupation Employer 5. TOTAL ITEMIZED CONTRIBUTIONS (Carry forward to item 3. of next page if additional pages of this form are used.) (If this is the last page of contributions, this amount must be shown in item 15b. of summary.) 7 Page of RDA 1159 0 SS-1131(Rev. 2106) 1 ITEMIZED STATEMENT OF IN-KIND CONTRIBUTIONS - CANDIDATE 1. NAME OF CANDIDATE OR COMMITME 2. REPORT OVERING THE PER D FROM: TO: mount 3. TOTAL ITEMIZED IN-KIND CONTRIBUTIONS FROM PRECEDING PAGE (enter $0 if first itemized page) 4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED IN-KIND CONTRIBUTION (in-kind contributions totaling more than $100 from any contributor during the period) First Name Middle Name In-Kind Contribution Received For: Value of In-Kind Contribution Last Name/Organization Name ❑ Primary Election ❑ General Election ❑ Runoff (Local Elections Only) Address Dale of In-Kind Contribution Aggregate this Election City State Zip Code Description of In-Kind Contribution Occupation Employer First Name Middle Name In-Kind Contribution Received For: Value of In-Kind Contribution taslNamel El Primary Election ❑ General Election Organization Name ❑ Runoff (Local Elections Only) Address Date of InAnd Contribution Aggregate this Election city State Zip Code Description of In-Kind Contribution Occupation Employer First Name Middle Name In-Kind Contribution Received For: Value of In-Kind Contribution Last Name/Organization Name E] Primary Election ❑ General Election ❑ Runoff (Local Elections Only) Address Date of In-Kind Contribution Aggregate this Election City State Zip Code Description of In-Kind Contribution Occupation m over Value of In-Kind Contribution 7-Address Middle Name In-Kind Contribution Received For: 11 Primary Election 11 General Election ❑ Runoff (Local Elections Only) Date o f In-Kind Contribution Aggregate this Election city State_ I Zip Code Description of In-Kind Contribution Occupation Employer First Name Middle Name In-Kind Contribution Received For: Value of In-Kind Contribution ❑ Primary Election E] General Election Last NamefOrganization Name El Runoff (Local Elections Only) Address Date of In-Kind Contribution Aggregate this Election city State Zip Code Description of In-Kind Contribution Occupation m yer 5. TOTAL ITEMIZED IN-KIND CONTRIBUTIONS (Carry forward to item 3. of next page If additional pages of this form are used.) (If this is the last page of in-kind contributions, this amount must be shown in Item 22b. of summary.) IV1 QP SS-1128 (Rev. 2106) Page of RDA 1159 l ITEMIZED STATEMENT OF EXPENDITURES - CANDIDATE 1. NAME OF CANDIDATE OR C MMI E 2. REPOR COVERING THE ERIOD FROM: T0: moun 3. TOTAL ITEMIZED CAMPAIGN EXPENDITURES FROM PRECEDING PAGE (enter $0 if first itemized page) 4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED EXPENDITURE (expenditures totaling more than $100 to any payee during the period) First Name Middle Name Purpose of Expenditure Amount of Expenditure Last Name/Business Name + Address City State Zip Code First Name Middle Name Purpose of Expenditure Amount of Expenditure Last Name/Business Name Address City State Zip Code { Y! I First Name Middle Name Purpose of Expenditure Amount of Expenditure Last Name/Busi s ame P Address ~a City State Zip Coda First Name Middle Name Purpose of Expenditure Amount of Expenditure Last NameBusige;sldame Address IY~`~ City State Zip Code First Name Middle Name Purpose of Expenditure Amount of Expenditure Last N usin ss Name C c Address City _ State Zip Code ~ ~ kyW I I 0 First Name Middle Name Purpose of Expenditure Amount of Expenditure Last NamelBksinec&NAme Address City State Zip Code 5. TOTAL ITEMIZED EXPENDITURES (Carry forward to item 3. of next page If additional pages of this form are used.) (If this is the last page of expenditures, this amount must be shown in item 19b. of summary.) SS-1129 (Rev. 4102) Page of RDA 1159 1 ITEMIZED STATEMENT OF LOANS - CANDIDATE 1. NAME OF CAN IDATE OR COM ITTEE 2. REP RT COVERING THE ERIOD r FROM: TO: 77COMPLET THE APPROPRIATE ITEMS FOR EACH ITEMIZED LOAN (loans totaling more than $100 from any source du ing the period) Complete the Following for the Source of the Loan First Name Middle Name Outstanding Loan Balance Loans Loan Outstanding Loan Balance (Beginning of Period) Received Payments (End of Period) Last Name/Organization Name Address Loan Received For: Date of can ❑ Primary Election ❑ General Election City State Zip Code ❑ Runoff (Local Elections Only) List All Endorsers or Guarantors for Above Loan (If more space is needed please attach a page) s: First Name Middle Name First Name Middle Name Last Name/Organization Name Last Name/Organization Name Address Address City State Zip Code Gty State Zip Code Amount Guaranteed Outstanding Amount Guaranteed Outstanding First Name Middle Name First Name Middle Name Last Name/Organization Name Last NamelOrganizabon Name Address Address City State Zip Code City State Zip Code Amount Guaranteed Outstanding Amount Guaranteed Outstanding First Name Middle Name First Name Middle Name Last Name/Organization Name Last Name/Organization Name Address Address city -7Zip Code City State Zip Code Amount Guaranteed Outstanding mount Guaranteed Outstanding First Name Middle Name First Name Middle Name Last Name/Organization Name Last Name/Organization Name Address Address Gty State Zip Code city State Zip Code Amount Guaranteed Outstanding Amount Guaranteed Outstanding 4. Totals for all Loans (complete on last page of itemized loans) Outstanding Loan Balance Loans Loan Outstanding Loan Balance (Total loans received should also be shown in item 16. on summary page.) (Beginning of Period Received Payments En77" (Total loan payments should also be shown in item 20. on summary page.) ~ (Total outstanding loan balance should also be shown in item 12.e. on front page.) Aft SS-1132 (Rev. 4/02) Page of RDA 1159 . ITEMIZED STATEMENT OF OBLIGATIONS - CANDIDATE 1. NAME OF CANDIDATE, R COMMIT 2. REPORT C VERING THE PERIOD FROM: T0: 3. COMPLETE THE APPROPR ATE ITtt Outstanding Balance Debt Incur a Payments Out andi g Balance OBLIGATION (obligations totaling more than $100 owed to any (Beginning of Period) This Period This Period (End of Period) person/vendor at the end of the reporting period) First Name Middle Name Last NamelBusiness Name Address city State Zip Code Description of Obligation First Name Middle Name Last Name/Business Name Address city Stale Zip Code Description of Obligation First Name Middle Name Last Name/Business Name Address city State Zip Code Description of Obligation First Name Middle Name Last Name/Business Name Address city State Zip Code Description of Obligation First Name Middle Name Last Name/Business Name Address city State Zip Code Description of Obligation 4. TOTALS (Total from Outstanding Balance - (End of Period) column must also be shown in item 23b. on summary page.) SS-1127 (Rev. 4102) Page of RDA 1159 CAMPAIGN FINANCIAL DISCLOSURE STATEMENT For State and Local Candidates For Single-Candidate Commi es ~4 _ , I 12.a. NAME OF CAN 14ATE OR CO I ~0 , 4 1. DATE OF REP RT 2.b. IF COMMIT E, N E OF NDIDA 3. ELECTION ATE ~c 0 e ~ 4.a. CAMPAI N ADDRESS AND PHONE Street or Rural Route City State Zip Code Phone Cf 21/ 4.b. CANDIDATE'S HOM A DRES (if different than 4.a.) Street or Rural Route City State Zip Code Phone I L '2770 ) -1 40 / 5. OFFICE SOUGHT (include district numb r, if applicable) 6. NAME OF POLITICAL TREASURE (ma a candidate) At . ^ Des+nz u ❑ ❑ ❑ ❑ 7. CATEGORY OR REPORT (Check one) FIRST SECOND THIRD FOURTH PRE- PRE- MID-YEAR YEAR-END QUARTER QUARTER QUARTER QUARTER PRIMARY G ERAL SUPPLEMENTAL SUPPLEMENTAL S.a. BEGINNING DATE IF R ORTING PERIOD 8.b. ENDIN DATE F REPORTING PERIOD 1 i~ a . 9. (Check one) a. ❑ This campaign is exempt from detailed disclosure because contributions (including in-kind) received total $1,000 or less AND expendi- tures total $1,000 or less for this reporting period. (Complete items 12d., 12e. and 12f.) b. LNJ i his campaign is required to file a detailed financial disclosure because contributions (including in-kind) received total more than $1,000 and/or expenditures total more than $1,000 for this reporting period. 10. I/we do solemnly swear or affirm that the information contained in this campaign financial disclosure report is true and that this report is an accurate accounting f campaign contributions and expenditures required to be reported by the candidate committee by the Campaign Financi I closur t. Additionally, we swear or affirm that no campaign contributions have en expended for Y)e personal financial benef a can or for any o r onpolitical rpos as defined by the federal intern nue c d 4 a signatur o candidate bate' j signature of political treasurer date 11. WITNESS SIGNATURE signature of witness date signature of witness date 12. SUMMARY )3)l ,L a. BALANCE ON HAND LAST REPORT $ 1 7 Q b. TOTAL RECEIPTS THIS PERIOD c. TOTAL DISBURSEMENTS THIS PERIOD $ d. BALANCE ON HAND (12.a. plus 12.b. minus 12.c.) $ / 1 ! l e. TOTAL LOANS OUTSTANDING $ f. TOTAL OBLIGATIONS OUTSTANDING $ AMIL SS-1109 (Rev. 2/06) Page 1 of RDA 1159 r SUMMARY PAGE - CANDIDATE 13. NAME OF CANDIDATE OR COMMITTEE (In Full) 14. REPORT COVERING THE PERIOD FROM: T0: RECEIPTS 15. CONTRIBUTIONS (other than loans and interest) rv a. Unitemized Contributions ($100 or less from each source this period) $ b. Itemized Contributions (over $100 from each source this period) $ o~G R t$y$~j c. TOTAL CONTRIBUTIONS (other than loans and interest)(add 15.a. and 15.b.) $ v,['rx~~+1 16. LOANS RECEIVED THIS REPORTING PERIOD $ 17. INTEREST RECEIVED THIS REPORTING PERIOD MQ 18. TOTAL RECEIPTS (add 15.c., 16., and 17.) (must be shown in item 12.b.) $ DISBURSEMENTS 19. EXPENDITURES (other than loan payments) ry - eg., printing, postage, gasoline) a. Expenditures ($100 or less each payee this period) (must be listed by categ*0-1W $ $ Total of Expenditures ($100 or less each payee) $ b. Itemized Expenditures (Over $100 each payee this period) _ Qk$ ° c. TOTAL EXPENDITURES (other than loan repayments)(add 19.a. and 19.b.) $ J 20. LOAN REPAYMENTS MADE THIS PERIOD 21. TOTAL DISBURSEMENTS (add 19.c. and 20.) (must be shown in item 12.c.) $ 22.IN-KIND CONTRIBUTIONS a. Unitemized in-kind contributions ($100 or less from each source this period) $ b. Itemized in-kind contributions (over $100 from each source this period) $ c. TOTAL IN-KIND CONTRIBUTIONS RECEIVED THIS PERIOD (add 22.a. and 22.b.) $ 23. OBLIGATIONS a. Unitemized Obligations Outstanding ($100 or less each) $ 0 b. Itemized Obligations Outstanding (Over $100 each) $ c. TOTAL OBLIGATIONS OUTSTANDING (add 23.a. and 23.b.) (must be shown i item 12.f.) $ SS-1133 (Rev. 4102) Page of ITEMIZED STATEMENT OF CONTRIBUTIONS - CANDIDATE 1. NAME F AN ATE 0 MITT 2. REPORT COVERING THE PERIOD I FROM: TO: q-.- 1y- 3. TOTAL ITEMIZED CAMPAIGN CONTRIBUTIONS FROM PRECEDING PAGE (enter $0 if first itemized page) Amount 4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED CONTRIBUTION (contributions totalin more than $100 from an contributor L J First Na r Middle Name Contribution Received For: Amount of Contribution J Last Na a/Or iza ' n Nam Primary Election ❑ General Election Address f g S Q El p I Runoff (Local Elections Only) City State Zip Code Date of Con ibution ~ Aggregate This Election Occupation ` 17 IJ L` l Employer First Name Middle Name Contribution Received For: Amount of Contribution Last Name/Organization Name ❑ Primary Election ❑ General Election Address ❑ Runoff (Local Elections Only) City State Zip Code Date of Contribution Aggregate This Election Occupation Employer First Name iddle Name Contribution Received For: Amount of Contribution as ame rgamza on Name ❑ Primary Election ❑ General Election Address ❑ Runoff (Local Elections Only) City State ZoCode Date of Contribution Aggregate This Election Occupation oyer First Name Middle Name Contribution eceived or: mount o ontn ution Last Name/Organization Name ❑ Primary Election ❑ General Election Address ❑ Runoff (Local Elections Only) Ciry State Zip Code Date of Contribution Aggregate This Election Occupation Employer 5. TOTAL ITEMIZED CONTRIBUTIONS 5o (Carry to item 3. of next page if additional pages this form are used.) (if this is Is Is the last page of contributions, this amount must be shown in Item 15b. of summary.) SS-1131(Rev. 2/06) Page • of RDA 1159 ITEMIZED STATEMENT OF IN-KIND CONTRIBUTIONS - CANDIDATE 1. NAME OF A DIDATE OM EE 2. REPORT C VERING THE P RIO TO: FROM: y L Annouril 3. TOTAL ITEMIZED IN-KIND CONTRIBUTIONS FROM PRECEDING PAGE (enter $0 if first itemized page) O 4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED IN-KIND CONTRIBUTION (in-kind contributions totaling more than $100 from any contributor during the period) First Name Middle Name In-Kind Contribution Received For: Value of In-Kind Contribution ❑ Primary Election ❑ General Election Last Name/Organization Name ❑ Runoff (Local Elections Only) Address Date of In-Kind Contribution Aggregate this Election City Stale Zip Code Description of In-Kind Contribution Occupation Employer First Name Middle Name In-Kind Contribution Received For: Value of In-Kind Contribution ❑ Primary Election ❑ General Election Last Name/Organization Name ❑ Runoff (Local Elections Only) Address Date of In-Kind Contribution Aggregate this Election City State Zip Code Description of In-Kind Contribution Occupation Employer First Name Middle Name In-Kind Contribution Received For: Value of In-Kind Contribution ❑ Primary Election ❑ General Election Last Name/Organization Name ❑ Runoff (Local Elections Only) Address Date of In-Kind Contribution Aggregate this Election city state Zip Code Description of In-Kind Contribution Occupation m over First Name Middle Name In-Kind Contribution Received For: Value of In-Kind Contribution ❑ Primary Election ❑ General Election Last Name/Organization Name ❑ Runoff (Local Elections Only) Address Date of In-Kind Contribution Aggregate this Election City State Zip Code Description of In-Kind Contribution Occupation Employer First Name Middle Name In-Kind Contribution Received For: Value of In-Kind Contribution ❑ Primary Election ❑ General Election Last NamelOrganization Name ❑ Runoff (Local Elections Only) Address Date of In Wnd Contribution Aggregate this Election City State Zip Code Description of In-KGnd Contribution Occupation m yer 5. TOTAL ITEMIZED IN-KIND CONTRIBUTIONS (Carry forward to item 3. of next page if additional pages of this form are used.) (If this is the last page of in-kind contributions, this amount must be shown in item 22b. of summary.) SS-1128 (Rev. 2106) Page of RDA 1169 ITEMIZED STATEMENT OF EXPENDITURES - CANDIDATE 1. NAME CANDIDAT OR C ITTEE 2. REPORT COVERING THE PERIOD ` FROM: q- T0: • f Amount 3. TOTAL ITEMIZED CAMPAIGN EXPENDITURES FROM PRECEDING PAGE (enter $0 if first itemized page) 1 -0 4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED EXPENDITURE (expenditures totaling more than $100 to any payee during the period) First Namee Middle Name Purpose of Expenditure ry,n Amount of Expenditure Last Name/Busine me Address (a~ City It'll, State Zip Code First Name Middle Name Purpose of Expenditure Amount of Expenditure Last Nam usin s Name VI~, 'J Ad ress t City 1/L O L9 ~J t State I Zip Code 717 First Name Middle Name Purpose of Expenditure Amount of Expenditure Last Name/Business Name Address City State Zip Code First Name Middle Name Purpose of Expenditure Amount of Expenditure Last Name/Business Name Address City Stale Zip Code First Name Middle Name Purpose of Expenditure Amount of Expenditure Last Name/Business Name Address City State Zip Code First Name Middle Name Purpose of Expenditure Amount of Expenditure Last Name/Business Name Address City State Zip Code 5. TOTAL ITEMIZED EXPENDITURES ry ~y t (Carry forward to item 3. of next page if additional pages of this form are used.) J (`Y!1 1 (If this is the last page of expenditures, this amount must be shown in item 19b. of summary.) Adhh SS-1129 (Rev. 4102) Page of RDA 1159 ITEMIZED STATEMENT OF LOANS - CANDIDATE 1. NAME OF C NDIDATE 0 MMIT E 2. REPORT COVERING THE )PERIOD / FRO TO: 3. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED LOAN (loans totaling more than S1oo from any sou d ring the period) Complete the Following for the Source of the Loan L Name Middle Name Outstanding Loan Balance Loans Loan Outstanding Loan Balance (Beginning of Period) Received Payments (End of Period) Lest Name/Organization Name Address Loan Received For: Date of Loan ❑ PrimaryElection 13 General Election city State Zip Code ❑ RunoB (Local Elections Only) List All Endorsers or Guarantors for Above Loan (If more space is needed please attach a page) First Name Middle Name First Name Middle Name Last Name/Organization Name Last Name/Organization Name Address Address City State Zip Code City State Zip Code Amount Guaranteed Outstanding mount Guaranteed Outstanding First Name Middle Nama First Name Middle Name Last Name/Organization Name Last Name/Organization Name Address Address city State Zip Code city State Zip Code Amount Guaranteed Outstanding Amount Guaranteed Outstanding First Name Middle Name First Name Middle Name Last Name/Organization Name Last Name/Organization Name Address Address Gty State Zip Code City State Lp Code Amount Guaranteed Outstanding Amount Guaranteed Outstanding First Name Middle Name First Name Middle Name Last Name/Organization Name Last Name/Organization Name Address Address Gty State Zip Code City State Zip Code Amount Guaranteed Outstanding mount Guaranteed Outstanding 4. Totals for all Loans (complete on last page of itemized loans) Outstanding Loan Balance Loans Loan Outstanding Loan Balance (Total loans received should also be shown in item 16. on summary page.) (Beginning of Period Received Pa menu End of Period (Total loan payments should also be shown in item 20. on summary page.) (Total outstanding loan balance should also be shown in item 12.e. on front page.) / - p SS-1132 (Rev. 4/02) Page of RDA 1159 ITEMIZED STATEMENT OF OBLIGATIONS - CANDIDATE 1. NAME OF CA I QT OR COMM T 2. REPORT 0 ERING THE PERIOD ,l FROM: T0: 3. COMPLET THE APPROPRIATE ITEMS FOR EACH ITEMIZED Outstanding Balance Debt IncultrecIF Payments 0 island g B lance OBLIGATION (obligations totaling more than $100 owed to any (Beginning of Period) This Period This Period (End of Period) person/vendor at the end of the reporting period) First Name Middle Name Last NameBusiness Name Address city State Zip Code Description of Obligation First Name Middle Name -Last Name/Business Name Address city state Zip Code Description of Obligation First Name Middle Name Last Name/Business Name Address City State Zip Code Description of Obligation First Name Middle Name Last Name/Business Name Address City State Zip Code Description of Obligation First Name Middle Name Last Name/Business Name Address City State Zip Code Description of Obligation 4. TOTALS (Total from Outstanding Balance - (End of Period) column must also be shown icy, c~ lu' in item 23b. on summary page.) ~r ® SS-1127 (Rev. 4102) Page f of RDA 1159 SURF. STATEMENT , ~ FINANCIAL pIgCLOS didate Committees ForState and Local judicial single -can E OF CANDIDATE 1',( 2.a. NAM 3. ELECTION DATE ` 1 DATE OF REPORT q W'k (~i 1 CANDIDATE'S CO MITTEE ph A Phone 2.b. NAME OF State Zip Code ~ ~'7 O ~ S AND PHONE phone 4.a. CAMPAIGN ADDRES City Street or Rural Route a~ ~ it\sOa State Zip Code different than 4.a.) Ci 4.b. CANDIDATE'S HOME ADDRESS rf Street or Rural Route 1 6. a I if applicable) AME OF POLITICAL TREASURER 5 JUDICIAL OFF CE SOUGHT (include district number, L~ ❑ ❑ C ,p~f ~O `~~1 1 1 ❑ IP FYMER YEAR END OR T (Check one) C3 P ❑3 PRE MSUP SUCORYG~ O❑ ❑ FOURTH GENERAL NG A TER Q gR OpR QUARTER B bRl ENNDDI G D TE OF REPORTING PERIOD FlRST SECOND QUARTER ATE OF REPORTING PE S.a. BEGIN g. (Check o e) because contributions (including in-kind) received total $1,000 or less AND I t from detailed disclosures period. (Complete items 12d., 12e, and 12f.) received total more than $1,000 r-1 This campaign is exempt orting in-kind) a, this rep expenditures total $1,000 or less for ecause contributions including SURER q/ This campaign is required to fie a than $1,0detailed00 for financial disclosure b period. b. expenditures total more and/or 11 SIGNATUREOFPOLITICALTR to. SIGNATURE ~ I do solemnly swear or affirms the information DIDATE 0 I swear or and accurate~Additionally'scemPalgn financial disclosure report ose personal affirm that no campaign contributions have been expended for the al he can id to or for any other nonpolitical Pure Date financial benefit defined by the ral i t ignatue of Candidate revenue e S I~ I~ ate Signat r of P i e urer Date Signatue of Witness Date Signatue of Witness 12. SUMMARY © , Q a. BALANCE ON HAND LAST REPORT b. TOTAL RECEIPTS THIS PERIOD $ c. TOTAL DISBURSEMENTS THIS PERIOD $ d. BALANCE ON HAND (12.a. plus 12.b. minus 12.c.) e. TOTAL LOANS OUTSTANDING f. TOTAL OBLIGATIONS OUTSTANDING Page 1 0' JOk ItDp 1159 SS-1137 (Rev. 2/06) SUMMARY PAGE - CANDIDATE 13. NAME OF CANDIDATE OR COMMITTEE (In Full) 11 14. REPORT COVERING T E P RIOD FR OM: I T0: 3 I RECEIPTS 15. CONTRIBUTIONS (other than loans and interest) a. Unitemized Contributions ($100 or less from each source this period) $ . a00 ,coo b. Itemized Contributions (over $100 from each source this period) $ c. TOTAL CONTRIBUTIONS (other than loans and interest)(add 15.a. and 15.b.) dU' ~Q 16. LOANS RECEIVED THIS REPORTING PERIOD $ 17. INTEREST RECEIVED THIS REPORTING PERIOD l 18. TOTAL RECEIPTS (add 15.c., 16., and 17.) (must be shown in item 12.b.) DISBURSEMENTS 19. EXPENDITURES (other than loan payments) a. Expenditures ($100 or I s each payee this period) (must be listed by category - e.g., printing, postage, gasoline) 4 $ ► ov,f~' ig;x _j $ A $ $ $ $ $ $ $ Total of Expenditures ($100 or less each payee) $ b. Itemized Expenditures (Over $100 each payee this period) $ a c. TOTAL EXPENDITURES (other than loan repayments)(add 19.a. and 19.b.) $ 20. LOAN REPAYMENTS MADE THIS PERIOD - '0 V / 21. TOTAL DISBURSEMENTS (add 19.c. and 20.) (must be shown in item 12.c.) $ 22.IN-KIND CONTRIBUTIONS a. Unitemized in-kind contributions ($100 or less from each source this period) $ C~ r b. Itemized in-kind contributions (over $100 from each source this period) $ d c. TOTAL IN-KIND CONTRIBUTIONS RECEIVED THIS PERIOD (add 22.a. and 22.b. $ ` 23. OBLIGATIONS a. Unitemized Obligations Outstanding $100 or less each) $ b. Itemized Obligations Outstanding (Over $100 each) $ c, TOTAL OBLIGATIONS OUTSTANDING (add 23.a. and 23.b.) (must be shown i item 12.f.) $ harh SS 1133 (Rev. 4102) Page of _ i ITEMIZED STATEMENT OF CONTRIBUTIONS - CANDIDATE 1. NAME OF CANDIDATE OR COMMITT E C 2. REPORT COVERING THE P IOD FROM: T0: 3. TOTAL ITEMIZED CAMPAIGN CONTRIBUTIONS FROM PRECEDING PAGE (enter $0 if first itemized page) Amount 4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED CONTRIBUTION contributions totalin more than $100 from an contributor First Name- - Middle Name \ Contribution Received For. Amount of Contribution Last Name/Organization Name 11 Primary Election 11 General Election e Address 1 1n A. El Runoff (Local Elections Only) 1 ~L city • 1V, State zi Date of Contribution Aggregate This Election Occupation Employer n~ CA5 First Name Middle Na Contribution Received For: Amount of Contribution Last Name/ an' Wit Nam U Primary Election ❑ General Election ()0 Add ~ ress ❑Runoff A (Local Elections Only) ~ CV city l Shale Zip Code Date of Contribution ( Aggregate This Election Occupation A r Ernpbyer 1N/Il cr First Name Middle Name Contribution Received For: Amount of Contribution anrzatgn ame ❑ Primary Election ❑ General Election Address ❑ Runoff (Local Elections Only) City Site Zip Code Date of Contribution Aggregate This Election Occupation First Name Middle Name Contribution ecer or. cunt o Contribution Last Name/ Organization Name ❑ Primary Election ❑ General Election Address ❑ Runoff (Local Elections Only) city State Zip Cade Date of Contribution Aggregate This Election Occupation Employer 5. TOTAL ITEMIZED CONTRIBUTIONS (Carry forward to item 3. of nerd paged additional pages of this form are used.) (If this is the last page of contributions, this amount must be shown in item 15b. of summary.) 3 1r~ o SS-1131(Rev. 2/06) Page of RDA 1159 ITEMIZED STATEMENT OF EXPENDITURES - CANDIDATE 1. NAME OF CANDIDATE OR COMM TTEE 2. REPORT COVERING THE PERIOD FROM: TO: AMC & 3. TOTAL ITEMIZED CAMPAIGN EXPENDITURES FROM PRECEDING PAGE (enter $0 tf first itemized page) - (3 4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED EXPENDITURE (expenditures totaling more than $100 to any payee during the period) First Name Middle Name Purpose of Expenditure Amount of Expenditure LastNap Address Oryess ame t ` ) n 1 ut, ' A ry l L~Ie Gty 0 Y n A~ State vC V v 1 c i First Name Middle Name Purpose of Expenditure Amount of Expenditure Last NamerBMl V Address n , ,`lL,~ I / c f City Y J State Zip Code ~i VV ce, r14"~ ~11 9-1-15(p Name Middle Name Purpose of Expenditure Amount of Expendibure Last Name/Business Name Address City State Zip Code First Name Middle Name Purpose of Expenditure Amount of Expenditure Last Name/Business Name Address Gty State Zip Code First Name Middle Name Purpose of Expenditure Amount of Expenditure Last NameuBusiness Name Address City State Zip Code First Name Middle Name Purpose of Expenditure Amount of Expenditure Last NamelBusiness Nave Address City State Zip Code 5. TOTAL ITEMIZED EXPENDITURES (Cary forward to item 3. of next page it additional pages of this form are used.) (If this is the last page of expenditures, this amount must be shown in item 19b. of summary.) SS-1129 (Rev. 4/02) Page .S_ of _ RDA 1159 Appointment of Political Treasurer ~l For State and Local Candidates and Single-Candidate Committees F'0 INSTRUCTIONS The Appointment of Political Treasurer statement must be used to appoint a political treasurer as required by the Campaign Financial Disclosure Act (T.C.A. § 2-10-105) for state and local candidates and single- candidate political campaign committees. A state candidate may not receive or expend funds for an election until a political treasurer has been appointed for that election. A local candidate pursuant to T.C.A 2-10-101, maybe exempt from completing this form, please check with county election commission for more information. A candidate may appoint himself or herself as political treasurer. A new form must be filed if the treasurer is changed. Candidates for state public office must file their original Appointment of Political Treasurer statement ONLY with the Registry of Election Finance, 404 James Robertson Parkway, Suite 104, Nashville, TN 37243-1360. Candidates for local public office must file their original Appointment of Political Treasurer statement ONLY with their county election commission. 1. Datp: 2. Name of Candidate orCommitt~e: 3. Candidate %mall address: -A] &Yk > ii t 4. Campaign Address and Phone: City State Zip Code Phone 0 70 V S. Home Address and Phone (if different than item 4 above): City State Zip Code Phone .7 &G- A-I- 1 l ge~ l lack ~ S 1~- 6.Office e Sought (inclu distnct number, if applkable) 7. Party Affliation 8. Election Year easur e-mail address: 9. Treasurer Name: 10.1 r I'll ~Vk 11. Treasurer Address and Phone: City State Zip Code Phone 12. Candidate and Tre urer Signature (both signatures must be witnessed. Treasurer can not itness candidate's signature): 4 Signature of Candidate Signature of Treasurer X v Signature of Witness Signature of Witness Registry of Election Finance SS-1120 (rev 1012010)